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FAIRVIEW HOME INFUSION DULUTH
DSH240080 UNIVERSITY OF MINNESOTA MEDICAL CENTER
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Covered Entity Details
Entity Name
UNIVERSITY OF MINNESOTA MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240080
Entity Address
500 HARVARD ST. SE
MINNEAPOLIS, MN 55455
Medicare Provider Number
240080
Participating Start Date
7/1/2006
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
FAIRVIEW HOME INFUSION DULUTH
Pharmacy Address
1527 LONDON RD
DULUTH, MN 55812-1617
Pharmacy Comments
Contract Details
Approval Date
10/12/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Daniel M. Fromm, Sr. VP and CFO, Fairview Health Services
(612) 672-4976
Contract Pharmacy Representative
Fairview
Tim Affeldt, VP of Specialty/Infusion Operations
(612) 672-5127
Signed By Date
10/12/2018
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